Your Questions
Your Questions
Q: Dr. Eppley, I am interested in implants for a frontonasal augmentation effect. Would it be possible to place a nose bridge implant so that it extends onto the forehead and fans out, so that it kind of gives the effects of a forehead augmentation as well? I am look to create the look of deeper set eyes. Also, how much for each of those procedures? Thanks.
A: I suspect you are referring to augmentation of the glabellar region of the forehead just above the nose. While both areas can be augmented concurrently (frontonasal augmentation), they can not be done using a single implant or through the same incisional approach. While such an implant can be custom designed, one has to consider the logistics of it surgical placement. Such a frontonasal implant would be too big to pass it into the forehead through an open rhinoplasty approach. Conversely an adequate nasal pocket could not be made from any type of superior or scalp incisional approach unless it was an complete corral scalp incision. These are general statements and I would have to know more about the exact forehead and nasal areas you want to augment to determine their applicability to your aesthetic facial needs.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a glabellar implant. My interest in glabellar augmentation is that as I have had rhinoplasty and fat graft to forehead but my glabellar region is flat in comparison. I would be interested in knowing whether it looks natural when raising eyebrows and facial movement? Is there a visible border from the implant? Also what is the recovery time?
A: While glabellar augmentation can be done by a variety of materials and techiques, the most successful method is a custom glabellar implant made from the patient’s 3D CT scan. Since the glabella is a broad-based region that is like a diamond shape, it is best to have it custom made so that it blends smoothly to the surrounding bone and would have no visible or palpable edges. It is placed in the subperiosteal plane from an endoscopic scalp technique so it does interfere with any eyebrow or forehead movements. The glabellar implant is placed through a small scalp incision after the subperiosteal pocket has been made using the endoscope. The recovery time is very quick with limited swelling that should largely be resolved in a week after the procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in brow bone reshaping. I am wondering whether it is possible to make the inner corner of my brow ridge-glabellar more sloped. I would attach my photos in order to better address my requests to see if they are achievable. I am also attaching an example of the brow shape I am after as I think his brow ridge shape is very elegant. I found out that the formation of the triangular contour that I desire is formed by the downward slope of brow bone in the inner eye corner. Is it possible to, besides make the ridge-line more prominent, also make it more sloped?
Also, I had a previous glabellar implant (not fixed) which has an undesired shape and bad connectivity with my forehead and brow-ridge. I’m 100% sure that I’ll remove this graft sometimes (if not now, it has to be during my revision rhino), but I’m wondering whether it possible to remove this portion with the same incision of brow implant? I have consulted some doctors and they said the position of this graft is relatively high so it’s easier to remove this from upper incision instead of the incision of open rhino. How do you think?
A: When it comes to brow bone reshaping, the ability for remove bone along the medial supraorbital rim depends on two factors. First, the thickness of the rim bone in that area. you have to remember that the frontal sinus lies immediately beneath it. The bone is undoubtably a few millimeters thick so some change is possible, it is just a question of how much. Secondly, it requires good incisional access to reach down that low. No endoscopic or other more limited incisional technique will work.
Wherever the glabellar implant is located, it most certainly can not be removed through an open rhinoplasty incision. It must come out the way it was put in.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley,I am a young African American woman. I have a larger forehead which I can live with. The problem I have is that since my forehead is wide and protrudes and my nose is stubby, it makes my glabella look flat and too wide. I would like a glabella that makes my face look more define. What do you suggest? Thank you.
A: Thank you for your inquiry and sending your pictures. What you really have is a combined glabellar (forehead) and nasal bridge ‘defect’ or recessed area. This glabellar-nasal area lacks the protrusion and dimensions that the rest of your face has so it is disproportionate. (or as you have accurately stated…too flat) Building up this area could be done in multiple ways. The simplest would be fat injections but that carries with it the unpredictability of how well the fat would survive. The best approach is to really have a custom glabellar-nasal bridge implant made as a single piece. A standard preformed nasal implant will not augment the globular region of the forehead. Such a custom nasal implant would be placed through an open rhinoplasty approach (low) with an endoscopic technique from above. Other strategies include a preformed nasal bridge implant combined with bone cement augmentation of the glabella. As you can see there are various augmentative strategies using different materials.
Dr. Barry Eppley
Indianapolis, Indiana